Insurance Limitations and Cost of Triptans Negatively Influence Use Patterns, Quality of Life

June 18, 2007

June 18, 2007 (Chicago) -- During a migraine attack, physicians stress the importance of taking triptans early to achieve optimal efficacy. Results of a new study, however, indicate that 42% of migraine patients surveyed had insurance plans that do not provide adequate triptan doses per month, while 37% of these patients have forgone filling a triptan prescription because of cost.

The study also indicates that 63% of the patients will save triptan use for bad migraines due to cost and insurance issues. Migraine sufferers concerned with these 2 issues had significantly poorer triptan use patterns and reduced quality-of-life scores.

The results were presented during the American Headache Society 49th Annual Scientific Meeting here.

"This study is important because migraine sufferers suffer needlessly due to the fact that many insurance companies allow only 4 doses of triptans a month," Robert A. Nicholson, PhD, lead investigator of the study and assistant professor at St. Louis University School of Medicine and School of Public Health, in Missouri, told Medscape. "These people are in a quandary because they figure if it's not a migraine, they don't want to 'waste' a pill. But research has shown that if people think it's a migraine, they're almost always right."

The Effects of Restrictions

Many insurance companies limit the number of migraine pills people are allowed each month, so sufferers forgo taking the medication when they need it because they are afraid of running out, Dr. Nicholson explained. This translates into many people unnecessarily living with potentially disabling migraine pain and suffering poorer quality of life than they would have if they took their medication when needed.

The objective of this study was to evaluate the extent of cost and formulary restrictions and their impact on triptan use patterns in patients with migraines.

A total of 233 patients with migraine, the majority of whom were women, from a tertiary headache center, the Ryan Headache Center/Mercy Health Research at St. Louis University School of Medicine, completed a survey of triptan use/adherence, triptan cost, and insurance-related issues such as formulary and quantity restrictions, as well as quality-of-life measures, including the Headache Impact Test-6 (HIT-6) and Migraine Specific Quality of Life (MSQ) scales.

Analyses were conducted using X2, analysis of variance, and analysis of covariance (controlling for headache days per month, age, and sex) as applicable. Groups did not differ on age, sex, years with headache, headache severity, or presence of depression or anxiety.

Scores on the MSQ and HIT-6 with no limitations in their insurance than those who had insurance with insurance-cost limits ( P < .001). Those who waited to take a triptan had poorer quality of life ( P < .001). The interaction for quality-of-life variables was also significant ( P < .001), such that those with insurance or insurance as well as cost limitations who waited to take a triptan had poorer quality of life than those who had the same limitations but did not wait.

Individuals with no triptan restrictions had significantly higher rates of optimal triptan use (79% vs 48%; P < .001), the authors added. Those with insurance lmitations or insurance plus cost limitations were also more likely to have been to the emergency department for a headache during the past 12 months, they note

Of the patients surveyed, 4 of 5 respondents thought triptans were the best migraine medications, yet only 49% of people with insurance limitations said they took a triptan at the first sign of pain, compared with 79% of those who had no insurance limitations, a significant difference. The average individual copay was $37 per month for triptans and $82 for headache medications as a whole.

Dr. Nicholsonbelieves this study helps document how insurance restrictions and cost can negatively affect people's lives by limiting their ability to optimally treat migraines.

The "Antithesis of Quality Care"

"I think this is an important poster, and 1 of the most clinically relevant posters presented at this year's meeting," Roger K. Cady, MD, medical director, Headache Care Center, Banyan Group, in Springfield, Missouri, told Medscape. Dr. Cady was not involved in the study.

"It points out a significant obstacle that is faced by millions of migraine suffers: restrictions placed on medications for treating migraine. These restrictions are the antithesis of quality healthcare and penalize sufferers by requiring them to hoard medications and endure unnecessary disability," he said.

"This is particularly true in light of the abundant knowledge base supporting early treatment of migraine and that indicates that waiting to treat migraine later is associated with lower efficacy for triptan medications," Dr. Cady added.

A grant was given to Dr. Nicholson for this study from the National Institutes of Health.

American Headache Society 49th Annual Scientific Meeting: Abstract 11. June 7-10, 2007.

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